Archives for: August 2008

ABSTRACT: New research is revealing that celiac disease may be one of the most common genetic diseases, affecting perhaps as many as 2 million Americans. A national survey published today, for example, estimates that 1 in 133 Americans has it.

COMMENTARY: Most doctors miss the diagnosis of celiac disease. It’s now clear that the textbook description of this once-obscure ailment is woefully incomplete and describes only a minority of cases.

Below the tip of the so-called celiac iceberg is a diverse world of illness that may include thousands of people suffering from various, seemingly unrelated conditions, such as anemia, osteoporosis, infertility, irritable bowel syndrome and chronic fatigue.

“We were taught in another way. We were looking in the wrong direction. We were not putting our face under the water to see the iceberg,” said Alessio Fasano, a gastroenterologist at the University of Maryland School of Medicine in Baltimore.

It is Fasano and his colleagues who are publishing the survey that estimates 1 in 133 Americans has celiac disease. About 40 percent of the afflicted report no symptoms, although the disease may be having inapparent effects, such as the loss of bone mass, subtle changes in mood and infertility. In close relatives of people with celiac disease, the ailment was especially common, with a prevalence of 1 in 22, according to the paper, which is appearing in the Archives of Internal Medicine.

Celiac disease is characterized by a chronic inflammation of the upper portion of the small intestine. This occurs in response to gluten and similar proteins found in wheat, rye and barley. In classical cases, this leads to vomiting and diarrhea in young children soon after cereals are introduced in the diet.

What’s now clear is that people can develop celiac disease throughout life and that they often have few, if any, intestinal symptoms.

The symptoms they do have often arise from deficiencies of nutrients absorbed in the affected part of the intestine, such as iron, calcium and fat-soluble vitamins.

Iron-deficiency anemia is the most common “clinical presentation” of adults with celiac disease. In Fasano’s survey, 30 percent of people in which the disease was newly diagnosed had joint pain. One quarter had fatigue. Six percent had osteoporosis.

Celiac disease is diagnosed by testing for three antibodies — anti-gliadin, anti-endomysial and anti-tissue transglutaminase — that are present when an affected person is exposed to gluten but disappear when the offending grains are no longer consumed.